Aspirus Health Job Shadow Application

Job Shadow Application
Aspirus Health job shadows are observation‑only experiences that allow participants to watch healthcare professionals perform their daily responsibilities. Hands‑on involvement in work tasks is not permitted. Applications are reviewed for accuracy and completeness, and incomplete submissions will not be considered. Submitting an application does not guarantee placement, and placement approval does not guarantee that all hours can be accommodated.
APPLICANT INFORMATION
Applicant legal name

First NameLast Name
Applicant date of birth

MonthDayYear
Must be at least 16 years old to shadow.
Applicant age
Must be at least 16 years old to shadow.
School or organization, if applicable
Applicant school or organization email, if applicable
example@example.com
Applicant expected month and year of college graduation, if applicable
Applicant personal email
example@example.com
Applicant phone number
Please enter a valid phone number.Format: (000) 000-0000.
Applicant home address

Street Address

Street Address Line 2

CityState

Zip Code
Emergency contact name

First NameLast Name
Emergency contact phone number
Please enter a valid phone number.Format: (000) 000-0000.
Are you currently employed by Aspirus Health?
Please specify your work location and department.
Please specify your intended shadowing location and department.
Current employee acknowledgement

SHADOWING REQUEST DETAILS
Shadow duration
Note: Additional documentation is required for the extended shadow option.
Total shadowing hours being requested for this year
Note: MAXIMUM 24 HOURS ALLOWED, UNLESS SHADOWING IS A SCHOOL PROGRAM PRE-REQUISITE. Requested hours are not guaranteed and are subject to department availability. For reporting purposes, a year is defined as September 1 - August 31.
Total shadowing hours being requested for this year
Note: Requested hours are not guaranteed and are subject to department availability. For reporting purposes, a year is defined as September 1 - August 31.
Check all that may apply to you.
Reason for shadow request
Choose one option above.
If other, please specify reason for request.
Degree or career of interest
If other, please specify degree or career of interest.
Please indicate one preferred department or service that you are interested in for your shadowing experience.
For assistance finding a service name, please visit https://www.aspirus.org/find-a-service
In the event that your preferred department or service is not available, please indicate one alternate department or service that you are interested in for your shadowing experience.
For assistance finding a service name, please visit https://www.aspirus.org/find-a-service
Location requested
If requesting a shadowing experience in a clinic setting, please enter the name of the clinic.
For assistance finding a clinic name, please visit https://search.aspirus.org/locations
Preferred person to shadow, if known

First NameLast Name
Earliest date applicant is available to shadow

MonthDayYear
NOTE: Date must be at least 4 weeks in the future to allow time for processing the request.
Latest date applicant is available to shadow

MonthDayYear
NOTE: Date must be at least 7 days after earliest date applicant is available to shadow.
Preferred days of the week applicant is available to shadow
Applicants under 18 who are shadowing in Michigan must obtain parent/guardian permission to participate. Parent/guardian: Please sign below to indicate that you are granting permission to participate, including providing required background study results for shadowing requests of over 8 hours, and that you acknowledge that the applicant may be contacted by Aspirus Health for recruiting purposes.
Parent/Guardian Signature

ONBOARDING DOCUMENTS REVIEW

Please open, save, and review all the documents below as a condition of your placement with Aspirus Health.
Code of Conduct

Compliance

Controlled Substance Handling and Diversion

Confidentiality Policy

Drug and Alcohol-Free Workplace Policy

Infection Prevention

Regulatory Review

Workplace Violence in Healthcare

Harassment & Discrimination Free Workplace Policy

Social Media/Networking Policy

Use of Personal/Company Provided Electronic Device Policy
Onboarding Documents Acknowledgement

I certify that I have reviewed all Aspirus Health shadow applicant onboarding documents linked above. By checking this box, I certify that I am responsible for understanding the information contained in all linked documents. Falsifying this statement or failure to comply with Aspirus Health policies will result in disciplinary action that may include expulsion from the facility for the remainder of the shadowing experience.

HEALTH HISTORY

Required for all standard and extended shadow experiences.
Allergy notification acknowledgement
Pregnancy notification acknowledgement
Communicable disease symptom acknowledgement

I understand that I am conducting a shadow experience in a healthcare facility and need to maintain infection control standards. I will not report to my shadow experience if I have any signs and symptoms of a contagious illness, such as fever, vomiting, diarrhea, or open skin lesions. I will be responsible for informing the person I am shadowing if I am unable to attend. By checking this box, I acknowledge that I have read and understand this requirement.
Influenza and COVID-19 vaccination recommendation acknowledgement

I understand that it is strongly recommended that I receive annual influenza vaccination and the current seasonal COVID-19 vaccination to help protect patients, staff, and myself by reducing the risk of infectious disease transmission in healthcare settings. I understand that flu season varies each year but generally begins on November 1 and ends sometime after March 31. By checking this box, I acknowledge this recommendation. If I choose to opt out of the annual influenza vaccination, I agree to inform the person I am shadowing, and I will wear a surgical mask for the entirety of my shadowing experience if it takes place during flu season. Opting out of the COVID-19 vaccination does not require wearing a surgical mask.
Influenza vaccination status
Choose the option that best describes your annual Influenza vaccination status for this year.
COVID-19 vaccination status
Choose the option that best describes your COVID-19 vaccination status for this year.
Upload proof of Influenza and/or COVID-19 vaccination, if applicable

PLEASE READ: All uploaded files must be official medical records and include the applicant's FULL NAME and DATE OF BIRTH. Handwritten documentation created by the applicant or the applicant's parent/guardian will not be accepted.
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Background Study Upload

Applicants who wish to complete more than 8 hours of shadowing in a year (September 1–August 31) must submit proof of a caregiver background study. If you do not currently have background study results to upload, please use the appropriate link below to complete one. Return to this page when your results are available and ready to upload. Any questions about the background study process should be directed to the resources linked below.
Michigan Background Study
- Enter First and Last Name
- Check all four Registries boxes before clicking Search
- Take a screenshot of your results on each of the 4 tabs
Minnesota Background Study
- Use Provider Name and Provider Code, as indicated
- Include your Social Security number in your background study to ensure it is processed completely.
- After submitting your MN background study request, email students@aspirus.org to confirm that your request has been submitted.
Wisconsin Background Study
- Click on PUBLIC ACCESS, then click SUBMIT REQUEST
- Accept SECURITY WARNING
- Background Request Type: CAREGIVER
Upload Current Background Study Results

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Employment Opportunities Acknowledgement

Prior to clicking Submit, please verify that your application is accurate and complete.
Should be Empty:

Job Shadow Application

APPLICANT INFORMATION

SHADOWING REQUEST DETAILS

ONBOARDING DOCUMENTS REVIEW

HEALTH HISTORY

IMMUNIZATION INFORMATION

TUBERCULOSIS (TB) SYMPTOM QUESTIONNAIRE AND RISK ASSESSMENT

Background Study Upload

Prior to clicking Submit, please verify that your application is accurate and complete.